The early diagnosis of hepatopulmonary syndrome by 99mTc-MAA scintigarphy in chronic liver disease [Kronik karaciger hastaliginda hepatopulmoner sendromun 99mTc-MAA sintigrafisi lie erken teshisi]
Küçük Resim Yok
Tarih
1997
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Patients with end-stage liver disease frequently exhibit pulmonary circulatory dysfunction manifested by intrapulmonary vascular shunting, and arterial hypoxemia. The aim of this study was to detect hepatopulmonary shunt syndrome (HPSS) developing in cirrhosis. Fifteen patients with cirrhosis (4 F, 11 M), 18 control cases (8 F. 10 M) were included study group. The mean age was 55±13 yr. and 50±15 yr, respectively. 99mTc-MAA scintigraphy, pulmonary function testing, pulmonary diffusion capacity, endoscopy, analyses of arterial blood gases, ultrasonography and the routine biochemical studies were performed. We detected esophageal varices in 13, spider in 8, clubbing in 3, orthodeoxia in 9, platypnea in 11, hypoxemia in 4 patients. Three patients were in CHILD A, 6 patients in B, and 6 patients in C. Although there was no a significant difference between two groups for PaO2 values measured in supine position, PaO2 values in erect position were significantly decreased in patients with chronic liver disease (p < 0.03). Patients' PaCO2 values in both position were higher than that of control cases (Supine: p<0.03 and Erect: p<0.02). We calculated right to left shunt index (SI) in the image obtained both 5 and 30 min after IV injection of 99mTc-MAA. In early images, SI calculated by using systemic activity / total activity ratio was 12.1±2.7% in patient group, and 5.0±1.1 % in control group. In late images, these values were 30.4±6.8 % and 14.3±3.2 %, respectively, (p< 0.05). A significant difference was not detected among CHILD groups. We determined that DLCO and DLCO / VA decreased in 9 patients. In patient group, DLCO (71±18%) and DLCO/ VA (73±19) were prominently lower than that ones in control group (98±9% and 87±6, p<0.008 and p<0.03). Consequently, we conclude that orthodeoxia, reduced DLCO and DLCO / VA and an increased shunt index calculated by using systemic activity / total activity ratio in early 99mTc-MAA images are useful parameters in the diagnosis of HPSS in cirrhotic patients.
Açıklama
Anahtar Kelimeler
99mTc-MAA scintigraphy, Cirrhosis, Intrapulmonary right to left shunt, Orthodeoxia
Kaynak
Turkish Journal of Gastroenterology
WoS Q Değeri
Scopus Q Değeri
Q3
Cilt
8
Sayı
4
